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移植内增压式双侧血管蒂腹壁下动脉穿支皮瓣行乳房再造的临床效果

宋达疆 李赞 章一新 周波 吕春柳 唐园园 易亮 罗振华 王志远 华占强 冯光

宋达疆, 李赞, 章一新, 等. 移植内增压式双侧血管蒂腹壁下动脉穿支皮瓣行乳房再造的临床效果[J]. 中华烧伤杂志, 2021, 37(12): 1143-1148. DOI: 10.3760/cma.j.cn501120-20200824-00390.
引用本文: 宋达疆, 李赞, 章一新, 等. 移植内增压式双侧血管蒂腹壁下动脉穿支皮瓣行乳房再造的临床效果[J]. 中华烧伤杂志, 2021, 37(12): 1143-1148. DOI: 10.3760/cma.j.cn501120-20200824-00390.
Song DJ,Li Z,Zhang YX,et al.Clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator flap in breast reconstruction[J].Chin J Burns,2021,37(12):1143-1148.DOI: 10.3760/cma.j.cn501120-20200824-00390.
Citation: Song DJ,Li Z,Zhang YX,et al.Clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator flap in breast reconstruction[J].Chin J Burns,2021,37(12):1143-1148.DOI: 10.3760/cma.j.cn501120-20200824-00390.

移植内增压式双侧血管蒂腹壁下动脉穿支皮瓣行乳房再造的临床效果

doi: 10.3760/cma.j.cn501120-20200824-00390
基金项目: 

湖南省卫生健康委科研课题项目 B2019092, 20201650, 20200829

湖南省自然科学基金科卫联合项目 2018JJ6028, S2018SFYLJS0174

湖南省技术创新引导计划项目 2018SK50906

长沙市科技计划基础研究项目 kq1901074, kq1901077

详细信息
    通讯作者:

    李赞,Email:zzanli@163.com

Clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator flap in breast reconstruction

Funds: 

Hunan Provincial Health and Family Planning Commission Project B2019092, 20201650, 20200829

Science and Health Planning Project of Hunan Provincial Natural Science Foundation 2018JJ6028, S2018SFYLJS0174

Hunan Technological Innovation Guidance Plan Project 2018SK50906

Basic Research Project of Science and Technology Plan of Changsha City kq1901074, kq1901077

More Information
    Corresponding author: Li Zan, Email: zzanli@163.com
  • 摘要:     目的   探讨移植内增压式双侧血管蒂腹壁下动脉穿支皮瓣行乳房再造的临床效果。    方法   采用回顾性观察性研究。2008年12月—2016年12月湖南省肿瘤医院整形外科收治24例符合入选标准的乳腺癌术后患者,均为女性,年龄28~51(36.5±1.6)岁,均采用内增压式双侧血管蒂腹壁下动脉穿支皮瓣行Ⅱ期乳房再造。根据内增压吻合血管类型,将内增压式双侧血管蒂腹壁下动脉穿支皮瓣分为3种类型:吻合血管蒂主干远端型、吻合血管蒂主干主要分支型和吻合血管蒂肌支型。皮瓣长(27.5±0.3)cm、宽(12.8±1.4)cm。供瓣区予以彻底止血后,间断缝合修补前鞘,完成脐重建,留置2根负压引流管,逐层缝合皮下组织及皮肤。皮瓣血管蒂与受区胸廓内血管吻合具体方式包括吻合1支动脉和1支静脉近端、吻合1支动脉和1支静脉近远端、吻合1支动脉和2支静脉近端。术后观察皮瓣成活、血运情况。随访观察再造乳房外形满意度、供区并发症、腹壁功能及瘢痕增生情况。    结果   术后,采用内增压式双侧血管蒂腹壁下动脉穿支皮瓣行Ⅱ期乳房再造术患者的皮瓣均顺利成活且血运良好。随访14~56(20±6)个月,患者再造乳房外形满意,腹部供区无并发症且仅遗留线性瘢痕,腹壁功能无明显受限。    结论   对有明确适应证的患者行游离内增压式双侧血管蒂腹壁下动脉穿支皮瓣移植,是自体组织乳房再造安全可靠、效果满意的选择方案。

     

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  • 1  3种携带双侧血管蒂的腹壁下动脉穿支皮瓣内增压类型示意图。1A.对侧血管蒂与同侧血管蒂主干远端吻合型;1B. 对侧血管蒂与同侧血管蒂主干主要分支吻合型;1C.对侧血管蒂与同侧血管蒂肌支吻合型

    注:①、②、③、④、⑤、⑥分别表示脐、穿支血管、对侧血管蒂、同侧血管蒂主干远端、同侧血管蒂主要分支、同侧血管蒂肌支

    2  内增压式游离腹壁下动脉穿支皮瓣在乳房再造中的血运重建方式。2A.腹壁下动脉穿支吻合胸廓内1支动脉和1支静脉近端;2B.腹壁下动脉穿支吻合胸廓内1支动脉和1支静脉近远端;2C.腹壁下动脉穿支吻合胸廓内1支动脉和2支静脉近端

    3  例1患者游离移植内增压式双侧血管蒂腹壁下动脉穿支皮瓣再造乳房。3A.术中设计,根据供区、受区情况确定手术范围;3B.受区胸廓内血管准备,显露左侧胸廓内动脉及其伴行静脉备用;3C.分离右侧腹壁血管蒂至接近其发出平面;3D.分离左侧腹壁下动脉穿支及血管蒂至其接近发出平面;3E.将右腹壁下动静脉近端与左腹壁下动静脉的肌支进行端端吻合,形成内增压;3F.内增压完成后,进一步完成左腹壁下动静脉和胸廓内动静脉近远端的端端吻合;3G.术后即刻;3H.术后32个月随访,乳房外形满意,腹部供区仅遗留线性瘢痕

    注:图3F中的①、②分别表示右侧腹壁下血管近端、左侧腹壁下血管

    4  例2患者行游离移植内增压式腹壁下动脉穿支皮瓣再造乳房。4A.术前根据乳房组织继发缺损程度及受区邻近皮肤缺损情况进行的设计;4B.双侧腹壁下血管蒂和穿支血管分离完毕,左侧腹壁下动静脉与右侧腹壁下动静脉主干远端吻合,形成内增压;4C.吲哚菁绿血管造影显示皮瓣血运良好;4D.右侧腹壁下动静脉与胸廓内动静脉吻合,腹壁下动脉2支伴行静脉分别与胸廓内静脉近远端吻合;4E.术中即刻;4F.术后18个月随访,乳房外观恢复满意

    注:图4B中的①、②分别表示左侧腹壁下血管、右侧腹壁下血管

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  • 收稿日期:  2020-08-24

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